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Health Inequalities

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Handbook of the Social Psychology of Inequality

Abstract

Research on health inequalities in the United States indicates that women, racial and ethnic minorities, and people of lower socioeconomic position are often at a health disadvantage compared to men, whites and those of higher socioeconomic position. However, these patterns are not uniform and appear contingent upon the dimension of inequality, the health outcome examined, and contextual factors. We show how attending to key social psychological processes helps illuminate the relationships between social inequalities and health, shedding light on these complex patterns. We review research on six key factors that have been proposed to explain health inequalities—stress exposures, environmental exposures, psychological dispositions, social relations, health behaviors, and health care interactions—as well as social comparison processes. Social psychological theories and concepts underscore that macro-level inequalities affect health and well-being for reasons other than material deprivations, and point to the importance of interpersonal interactions, identities, and symbolic meanings as interpretive processes that shape health inequalities.

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Notes

  1. 1.

    Research on health inequalities encompasses other dimensions of stratification such as immigrant status and sexual identity (Alegria et al. 2008; Cho et al. 2004; Saewyc 2011). Because the social psychological arguments that are invoked are similar, we emphasize these three key dimensions of stratification here.

  2. 2.

    Our review is necessarily selective. Literally thousands of studies of health inequalities have been published just in the past decade, many of which offer some social psychological insight. To keep our review manageable, we focus primarily on studies that explicitly invoke social psychological theories and concepts. Even within this narrow group of studies, space limitations prevent us from including all relevant citations.

  3. 3.

    The terms “social class,” “socioeconomic status,” and “socioeconomic position” are defined and used in various ways by health researchers. Of the three, the term socioeconomic position is the broadest. We use it here to avoid an unnecessary and unproductive alliance between our arguments and any more specific conceptualization.

  4. 4.

    We follow Williams et al. (2010) in using race to refer to racial and ethnic categories, both because the boundaries between the two concepts are fuzzy and for the sake of parsimony.

  5. 5.

    Several explanations have been proposed for the relatively high self-esteem observed among African Americans: that members of disadvantaged groups tend to compare themselves to similarly disadvantaged others; that they attribute failures or rejection to prejudice; that they devalue domains in which their group show relatively poor achievement; and that they hold positive group identities that protect self-esteem (see Twenge and Crocker 2002 for a review). However, why Latinos and Asian Americans report low self-esteem relative to whites and blacks, despite presumably having access to these same cognitive coping strategies, remains unclear.

  6. 6.

    A related argument has been presented in research on income inequality. In a small sample of OECD countries, Wilkinson (1992) documented a negative correlation between income inequality and life expectancy that appeared to be independent of absolute levels of income. One explanation given for the association was that income inequality erodes social bonds and diminishes social cohesion. Research by Kawachi et al. is consistent with this explanation in that state-level income inequality is negatively associated with levels of trust, and levels of trust are strongly associated with age-adjusted mortality (e.g., Kawachi et al. 1997, 1999). However, the basic association has been challenged by studies that incorporate more comprehensive controls, fixed effects models, or multilevel models (e.g., Beckfield 2004; McLeod et al. 2004; Sturm and Gresenz 2002), calling the social cohesion argument into question.

  7. 7.

    Although there is some debate over how much these habits and attitudes are products of success in formal educational settings, research on the role of non-cognitive traits in educational success demonstrates that teachers differentially reward students based on trustworthiness, dependability, and the like (Farkas 2003).

  8. 8.

    Socialization arguments have been extended to understanding why immigrant health deteriorates with the length of time spent in the U.S. (Lara et al. 2005). The major theoretical framework that has been used to understand this observation is the negative acculturation hypothesis (also referred to as “unhealthy assimilation”). The negative acculturation hypothesis asserts that the health advantage of immigrants declines as they begin to acculturate to American society and adopt the unhealthy lifestyles of their U.S. counterparts (Hunt et al. 2004; Lara et al. 2005; Schwartz et al. 2010).

  9. 9.

    While McKinlay (1996) identifies a disease that is under-recognized in women, other scholars have highlighted the over-production of disease in women through the medicalization of normal reproductive functions (e.g., pregnancy, childbirth, menstruation, menopause). By treating common and ordinary aspects of women’s reproductive lives as disease, the medical profession constructs an understanding of women as “sicker” than men which, in turn, affects women’s personal interpretations of their reproductive lives and, presumably, their self-reports of health (Conrad and Barker 2010; Riska 2003). In short, professional understandings of disease influence personal interpretations and the care that people receive in ways that reinforce those understandings.

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Correspondence to Jane D. McLeod .

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McLeod, J., Erving, C., Caputo, J. (2014). Health Inequalities. In: McLeod, J., Lawler, E., Schwalbe, M. (eds) Handbook of the Social Psychology of Inequality. Handbooks of Sociology and Social Research. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-9002-4_28

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